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Andrew D Pucker,1 Aaron M Kerr,2 Jennifer Sanderson,2 Chris Lievens2 1Clinical and Medical Sciences, Lexitas Pharma Services, Durham, NC, USA; 2Southern College of Optometry, Memphis, TN, USACorrespondence: Andrew D Pucker, Clinical and Medical Sciences, Lexitas Pharma Services, 5425 Page Road, Suite 410, Durham, NC, 27703, USA, Tel +1 (920)579-2900, Email andrewpucker@hotmail.comPurpose: Digital eye strain (DES) is a growing worldwide concern because digital devices are prevalent in both our work and home lives. The purpose of this review was to summarize clinically relevant and evolving key topics related to DES.Methods: A PubMed.gov search was conducted on or before June 8, 2024. No date restrictions were used during the primary search. The search was aimed at detecting all articles related to DES; thus, the search terms only included “digital eye strain” or “computer vision syndrome”.Results: The two most used, validated DES questionnaires are the Computer Vision Syndrome Questionnaire (CVS-Q) and Computer Vision Symptom Scale (CVSS17). The world-wide prevalence of DES ranges from 8.2% to 100% depending upon the subjects evaluated and the method used to evaluate them. The most common DES symptoms include headache, eye strain, eye redness, eye itching, tearing, photophobia, burning sensation, blurred vision, eye pain, neck and shoulder pain, and eye dryness. Ocular surface symptoms in DES are integrally tied to decreased blink frequency, which causes ocular surface desiccation, increased osmolarity, and dry eye-like symptoms. The most studied DES-specific treatments are improving subjects’ environment, artificial tears, blinking exercises, and near work breaks.Conclusion: DES is a highly prevalent condition that should be regularly screened for in clinic with a validated diagnosis instrument. While there are several treatment options, the community’s treatment approach is evolving and primarily focused on treating the visual and dry eye-like symptoms associated with the condition.Keywords: digital eye strain, computer vision syndrome, prevalence, digital device, symptoms

Abstract The effective design of combinatorial libraries to balance fitness and diversity facilitates the engineering of useful enzyme functions, particularly those that are poorly characterized or unknown in biology. We introduce MODIFY, a machine learning (ML) algorithm that learns from natural protein sequences to infer evolutionarily plausible mutations and predict enzyme fitness. MODIFY co-optimizes predicted fitness and sequence diversity of starting libraries, prioritizing high-fitness variants while ensuring broad sequence coverage. In silico evaluation shows that MODIFY outperforms state-of-the-art unsupervised methods in zero-shot fitness prediction and enables ML-guided directed evolution with enhanced efficiency. Using MODIFY, we engineer generalist biocatalysts derived from a thermostable cytochrome c to achieve enantioselective C-B and C-Si bond formation via a new-to-nature carbene transfer mechanism, leading to biocatalysts six mutations away from previously developed enzymes while exhibiting superior or comparable activities. These results demonstrate MODIFY’s potential in solving challenging enzyme engineering problems beyond the reach of classic directed evolution.

David Baldwin,1 Jonathan Carmichael,2 Gordon Cook,3 Neal Navani,4,5 James Peach,6 Ruth Slater,7 Pete Wheatstone,8 Julia Wilkins,7 Nicola Allen-Delingpole,9 Cicely EP Kerr,10 Khalid Siddiqui11 1Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; 2Department of Oncology, The National Institute for Health Research Leeds In Vitro Diagnostics Co-Operative (NIHR Leeds MIC), Leeds, UK; 3Cancer Research UK Trials Unit, LICTR, University of Leeds & NIHR (Leeds) IVD MIC, Leeds, UK; 4Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; 5Department of Thoracic Medicine, University College London Hospital, London, UK; 6Human Centric Drug Discovery, Wood Centre for Innovation, Oxford, UK; 7Health Economics Unit, London, UK; 8Patient and Public Involvement and Engagement Group, DATA-CAN, London, UK; 9The Association of the British Pharmaceutical Industry, London, UK; 10Research Data Scotland, Bayes Centre, Edinburgh, UK; 11Janssen-Cilag Ltd, High Wycombe, UKCorrespondence: James Peach, Human Centric Drug Discovery, Wood Centre for Innovation, Quarry Road, Oxford, OX3 8SB, UK, Email james@humancentricdd.comAbstract: Duration of overall survival in patients with cancer has lengthened due to earlier detection and improved treatments. However, these improvements have created challenges in assessing the impact of newer treatments, particularly those used early in the treatment pathway. As overall survival remains most decision-makers’ preferred primary endpoint, therapeutic innovations may take a long time to be introduced into clinical practice. Moreover, it is difficult to extrapolate findings to heterogeneous populations and address the concerns of patients wishing to evaluate everyday quality and extension of life. There is growing interest in the use of surrogate or interim endpoints to demonstrate robust treatment effects sooner than is possible with measurement of overall survival. It is hoped that they could speed up patients’ access to new drugs, combinations, and sequences, and inform treatment decision-making. However, while surrogate endpoints have been used by regulators for drug approvals, this has occurred on a case-by-case basis. Evidence standards are yet to be clearly defined for acceptability in health technology appraisals or to shape clinical practice. This article considers the relevance of the use of surrogate endpoints in cancer in the UK context, and explores whether collection and analysis of real-world UK data and evidence might contribute to validation.Keywords: cancer, surrogate endpoints, real-world data, multiple myeloma, lung cancer, quality of life

IntroductionColorectal cancer (CRC) is one of the main causes of deaths worldwide. Early detection and diagnosis of its precursor lesion, the polyp, is key to reduce its mortality and to improve procedure efficiency. During the last two decades, several computational methods have been proposed to assist clinicians in detection, segmentation and classification tasks but the lack of a common public validation framework makes it difficult to determine which of them is ready to be deployed in the exploration room.MethodsThis study presents a complete validation framework and we compare several methodologies for each of the polyp characterization tasks.ResultsResults show that the majority of the approaches are able to provide good performance for the detection and segmentation task, but that there is room for improvement regarding polyp classification.DiscussionWhile studied show promising results in the assistance of polyp detection and segmentation tasks, further research should be done in classification task to obtain reliable results to assist the clinicians during the procedure. The presented framework provides a standarized method for evaluating and comparing different approaches, which could facilitate the identification of clinically prepared assisting methods.

Introduction. The fifth edition of the Transatlantic Orthopedic Surgery Webinar 2023 occurred on December 4, 2023. The webinar’s main topic was treating equino-plano-valgus foot in children with cerebral palsy (CP). The event included speakers from Austria, Australia, China, India, Canada, Germany, Poland, Sweden, Turkey, the USA and the UK. Results. The first general session presented epidemiology, biomechanics, muscle function, equino-plano-valgus foot prevention options, and the Silverskiöld test in clinical assessment. It also discussed the principles of deformation treatment, options for orthotic treatment, and pathology treatment in adults suffering from CP. The surgical sessions presented comprehensive surgical techniques for the treatment of clubfoot equinus: sliding calcaneal osteotomy, lateral column lengthening with talonavicular arthrodesis, use of an expandable cage for the lateral column lengthening, double arthrodesis with the transfer of the peroneal muscles, percutaneous soft tissue release with/without arthroereisis, lateral column lengthening with arthroereisis, Grice procedure with talonavicular arthrodesis, lateral column lengthening with medial cuneiform bone plantarflexion osteotomy, lateral column lengthening with duplication of the talonavicular capsule, talonavicular and calcaneocuboid arthrodesis, transfer of the tibialis anterior muscle to the peroneal tertius muscle. The second general session presented methods of assessing the results of clubfoot treatment and postoperative rehabilitation protocols involving upright positioning and walking. Conclusion. The most important conclusions from the event are: clinical assessment and understanding the pathophysiology of the defect is crucial for its proper treatment; non-surgical treatment is recommended under the age of 6; between the ages of 6 and 14, surgical methods that preserve joint function predominate; after the age of 14 a large percentage of patients require performing joint arthrodesis. Nevertheless, arthrodesis should be avoided to correct flexible deformities and to treat patients with high functional requirements. The webinar audience included 583 people from 50 countries. Most participants came from Poland, Spain, Turkey, and Great Britain.

Kevin CJ Yuen,1 Lewis S Blevins,2 David R Clemmons,3 Mads Faurby,4 Andrew R Hoffman,5 Nicky Kelepouris,6 Janice M Kerr,7 Jens Magelund Tarp,4 Maria Fleseriu8 1Barrow Pituitary Center, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA; 2Department of Neurosurgery, University of California, San Francisco, CA, USA; 3Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; 4Global Evidence, Pricing and Access, Novo Nordisk A/S, Søborg, Denmark; 5Department of Medicine, Stanford University, Stanford, CA, USA; 6Department of Medical Affairs BioPharm, CMR, Novo Nordisk Inc., Plainsboro, NJ, USA; 7Department of Endocrinology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA; 8Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health and Science University, Portland, OR, USACorrespondence: Kevin CJ Yuen, Barrow Pituitary Center, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, 475 N. 5th Street, Phoenix, AZ, 85004, USA, Tel +1 602 406-2748, Fax +1 602 406-2770, Email kevin.yuen@commonspirit.orgPurpose: Adult growth hormone deficiency (AGHD) is often underdiagnosed and undertreated, leading to costly comorbidities. Previously, we developed an algorithm to identify individuals in a commercially insured US population with high, moderate, or low likelihood of having AGHD. Here, we estimate and compare direct medical costs by likelihood level.Patients and Methods: Retrospective, observational analysis using the Truven Health MarketScan database to analyze direct medical costs relating to inpatient and outpatient claims, outpatient prescription claims, medication usage, clinical utilization records, and healthcare expenditures. Patients were categorized into groups based on algorithmically determined likelihoods of AGHD. Likelihood groups were further stratified by age and sex. Trajectories of annual costs (USD) by likelihood level were also investigated.Results: The study cohort comprised 135 million US adults (aged ≥ 18 years). Individuals ranked as high-likelihood AGHD had a greater burden of comorbid illness, including cardiovascular disease and diabetes, than those ranked moderate- or low-likelihood. Those in the high-likelihood group had greater mean total direct medical monthly costs ($1844.51 [95% confidence interval (CI): 1841.24;1847.78]) than those in the moderate- ($945.65 [95% CI: 945.26;946.04]) and low-likelihood groups ($459.10 [95% CI: 458.95;459.25]). Outpatient visits accounted for the majority of costs overall, although cost per visit was substantially lower than for inpatient services. Costs tended to increase with age and peaked around the time that individuals were assigned a level of AGHD likelihood. Total direct medical costs in individuals with a high likelihood of AGHD exceeded those for individuals with moderate or low likelihood.Conclusion: Understanding the trajectory of healthcare costs in AGHD may help rationalize allocation of healthcare resources.Plain Language Summary: Growth hormone is an important substance found in the body. Adult growth hormone deficiency (AGHD) is the reduced production of growth hormone unrelated to the normal reduction seen with aging. Untreated AGHD can result in the development of other conditions, known as comorbidities, which can be expensive to manage.Previously, 135 million privately insured people in the US, aged 18– 64 years, were categorized into groups by their likelihood (high, medium, or low) of having AGHD. This study compared the estimated direct medical costs (eg hospital care and medication) across the different likelihood levels. People with a high likelihood of AGHD had more comorbidities than people with a medium/low likelihood, and an average total direct medical monthly cost of $1844.51, nearly twice as much as those with a medium likelihood ($945.65), and four times as much as those with a low likelihood ($459.10). These costs tended to increase with age, with the highest costs associated with people aged 50– 59 years and 60– 64 years. Outpatient costs (for treatments not requiring an overnight hospital stay) accounted for the greatest proportion of total medical costs, ahead of inpatient costs (for treatments requiring an overnight hospital stay) and medication costs.These findings suggest that diagnosing and treating AGHD earlier may help to reduce medical costs over time. Increased testing and treatment will cause an initial increase in the use of healthcare resources, but could improve overall cost effectiveness by reducing the long-term impact of the disease and avoiding unnecessary healthcare use. Keywords: AGHD, cost of comorbidities, cost of disease, likelihood of AGHD, medical costs, Truven Health MarketScan database

David Kerr,1 Jigar Ramesh Rajpura,2 Tarlan Namvar3 1Center for Health Systems Research, Sutter Health, Santa Barbara, CA, USA; 2Department of US Health Economic and Outcomes Research – Rare Disease Portfolio, Novo Nordisk Inc, Plainsboro, NJ, USA; 3Department of Evidence Synthesis and Value Assessment, Novo Nordisk Inc, Plainsboro, NJ, USACorrespondence: David Kerr, Diabetes Research and Digital Health Equity, Sutter Center for Health Systems Research, Santa Barbara, CA, USA, Tel +1 (805) 624-8688, Email david.kerr@sutterhealth.orgPurpose: The global burden of disease of type 2 diabetes (T2D) is significant, and insulin currently plays a central role in T2D management. This study sought to assess the preferences of patients with T2D and healthcare providers (HCPs) involved in T2D care regarding a hypothetical once-weekly basal insulin in comparison to current basal insulin options.Patients and Methods: In a survey-based study in the United States that included a discrete choice experiment (DCE), patients with T2D (insulin naïve and current insulin users) and providers who treat individuals with T2D were asked to evaluate current basal insulins and identify attributes of importance regarding a hypothetical once-weekly basal insulin. A regression analysis was conducted to identify drivers of preference by relevant demographics, attitudes, and behaviors.Results: Most respondents (91% of patients with T2D and 89% of HCPs in the base case scenario) would choose a once-weekly basal insulin product over another type of basal insulin. Both patients with T2D and HCPs rated insulin type and delivery method to be attributes of highest importance in the discrete choice exercise. Current basal insulin users (“insulin experienced”) reported higher levels of confidence that a once-weekly insulin would help them to achieve their desired blood sugar levels compared to their current basal insulin (5.7 vs 5.2 on a 7-point Likert scale). Most insulin-experienced respondents (88%) were likely to inquire about once-weekly basal insulin, and most HCPs (85%) indicated willingness to educate patients on management of their T2D using a once-weekly basal insulin.Conclusion: Discussing preferences for T2D medication management is important for patients and HCPs to ensure treatments are offered for patients based on their preferences. This study showed that patient and provider preferences are similar towards a once-weekly basal insulin over current basal insulin preparations.Plain Language Summary: Type 2 diabetes (T2D) is a medical condition where the body has difficulty managing insulin, a hormone used to control glucose, or sugar, that is broken down in the bloodstream. Many people with T2D have to take insulin to help their bodies manage their blood sugar effectively. We aimed to find out what people with T2D and healthcare providers (HCPs) think about a new type of basal insulin that only needs to be taken once a week, as compared to current basal insulins that are taken every day. We found that most people with T2D (91%) and HCPs (89%) would prefer a once-weekly insulin rather than another type of basal insulin. People with T2D currently taking insulin were also more confident that a once-weekly insulin could help control their blood sugar. Many people who are already using basal insulin (88%) said they would ask their HCP about a once-weekly insulin. HCPs said they were willing to educate patients about a once-weekly insulin (85%). This study shows that it is important for people with T2D and their HCPs to discuss what type of insulin is best for them, including the type of insulin and how often it is taken. Sharing preferences about medication options may be helpful in reducing the overall impact of the condition. Keywords: diabetes mellitus, type 2, insulin, long-acting, surveys and questionnaires, patient preference, provider preference

Polyp segmentation within colonoscopy video frames using deep learning models has the potential to automate colonoscopy screening procedures. This could help improve the early lesion detection rate and in vivo characterization of polyps which could develop into colorectal cancer. Recent state-of-the-art deep learning polyp segmentation models have combined Convolutional Neural Network (CNN) architectures and Transformer Network (TN) architectures. Motivated by the aim of improving the performance of polyp segmentation models and their robustness to data variations beyond those covered during training, we propose a new CNN-TN hybrid model named the FCB-SwinV2 Transformer. This model was created by making extensive modifications to the recent state-of-the-art FCN-Transformer, including replacing the TN branch architecture with a SwinV2 U-Net. The performance of the FCB-SwinV2 Transformer is evaluated on the popular colonoscopy segmentation benchmarking datasets Kvasir-SEG, CVC-ClinicDB and ETIS-LaribPolypDB. Generalizability tests are also conducted to determine if models can maintain accuracy when evaluated on data outside of the training distribution. The FCB-SwinV2 Transformer consistently achieves higher mean Dice and mean IoU scores when compared to other models reported in literature and therefore represents new state-of-the-art performance. The importance of understanding subtleties in evaluation metrics and dataset partitioning are also demonstrated and discussed. Code available: https://github.com/KerrFitzgerald/Polyp_FCB-SwinV2Transformer

Ethnographic-epidemiological (“ethno-epi”) research methodologies are increasingly being used to examine health-related issues, including the experiences of people who use drugs. However, the complementary application of random sampling from a well characterised cohort and qualitative data collection methods in a single study has not been described. We address this gap by sharing insights from the implementation of a novel random stratified sampling technique to recruit participants from two large prospective observational studies of people who use drugs into a qualitative study about impacts of the COVID-19 pandemic on their lived experience. We aim to describe how an ethno-epi approach we used can enhance the validity, reliability and generalizability of research findings in mixed methods investigations. We do so by providing a step-by-step description of the process we used to determine participant eligibility and recruitment into the qualitative study. Although the approach is not without limitations, findings underscore how ethno-epi random sampling approaches can increase the credibility and trustworthiness of qualitative findings without compromising data depth and integrity. Our study makes an important contribution to the growing number of new creative approaches being developed in the mixed methods research field and we hope that by sharing our account it will encourage and support others to consider the use of ethno-epi approaches in health-related research.

Verum focus has long been analysed as part of information structure, being accounted for within a theory of focus as generation of alternatives on a polarity value. Recently, however, this view has been challenged, with some authors arguing for a separation between verum and focus. The empirical debate focuses on two types of strategies: either verum is marked identically to focus (e.g., pitch accent in German, English) or through a dedicated strategy (e.g., dedicated markers in Gitksan, Bura, South Marghi). On the basis of the second type, it has been argued that the link between focus and verum is only superficial, with verum instead arising from a lexical operator VERUM. In this paper, we provide evidence in support of the traditional link between truth marking and focus, using original field data on the morphosyntactic expression of information structure in 11 Bantu (Niger-Congo) languages. By working from function to form, we show that these languages use a variety of grammatical strategies for truth expression, strategies that are used elsewhere in the information structural system for backgrounding. In this way, verum is not directly marked by focal accent but marked indirectly via backgrounding, which we formulate as the Backgrounding and Underspecification Thesis (BUT). On the basis of this Bantu evidence, we add a third type of strategy to the typology, where verum is marked indirectly via backgrounding. We use this updated typology to argue in favour of maintaining a conceptual link between verum, polarity focus, and predicated-centred focus more broadly.

Abstract Conventional additive manufacturing processes, where parts are built through layer-wise deposition of material on a horizontal plane, can be limiting when a part must be printed or fit onto uneven surfaces. Such situations will arise with increasing frequency as additive manufacturing application areas such as construction and medical devices continue to grow. In this work, we develop a simple and practical approach to generate toolpaths to print 3D structures onto uneven surfaces conformally. The algorithm uses only conventional planar toolpaths of both the structure to be printed and the substrate to be printed on and converts these to non-planar toolpaths, allowing easy integration with existing additive manufacturing workflows. The technique is demonstrated by printing flexible seals onto bespoke rigid face mask frames conformally via a conventional single-material 3D printer using the generated conformal toolpath. A notable improvement in air seal performance was observed for customized face masks with conformal soft seals compared to conventionally 3D-printed fully rigid face masks. This also shows the potential of the developed toolpath generation method to aid in the prototyping and fabrication of conformal medical and other devices.

Jason Shafrin,1 Kyi-Sin Than,1 Anmol Kanotra,1 Kirk W Kerr,2 Katie N Robinson,2 Michael C Willey3 1FTI Consulting, Center for Healthcare Economics and Policy, Los Angeles, CA, USA; 2Abbott Laboratories, Columbus, OH, USA; 3Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, IA, USACorrespondence: Jason Shafrin, Center for Healthcare Economics and Policy, FTI Consulting, Los Angeles, CA, USA, Tel +1 213-452-6483, Email Jason.Shafrin@fticonsulting.comObjective: To measure the economic impact of conditionally essential amino acids (CEAA) among patients with operative treatment for fractures.Methods: A decision tree model was created to estimate changes in annual health care costs and quality of life impact due to complications after patients underwent operative treatment to address a traumatic fracture. The intervention of interest was the use of CEAA alongside standard of care as compared to standard of care alone. Patients were required to be aged ≥ 18 and receive the surgery in a US Level 1 trauma center. The primary outcomes were rates of post-surgical complications, changes in patient quality adjusted life years (QALYs), and changes in cost. Cost savings were modeled as the incremental costs (in 2022 USD) of treating complications due to changes in complication rates.Results: The per-patient cost of complications under CEAA use was $12,215 compared to $17,118 under standard of care without CEAA. The net incremental cost savings per patient with CEAA use was $4902, accounting for a two-week supply cost of CEAA. The differences in quality-adjusted life years (QALYs) under CEAA use and no CEAA use was 0.013 per person (0.739 vs 0.726). Modeled to the US population of patients requiring fracture fixations in trauma centers, the total value of CEAA use compared to no CEAA use was $316 million with an increase of 813 QALYs per year. With a gain of 0.013 QALYs per person, valued at $150,000, and the incremental cost savings of $4902 resulted in net monetary benefit of $6852 per patient. The incremental cost-effectiveness ratio showed that the use of CEAA dominated standard of care.Conclusion: CEAA use after fracture fixation surgery is cost saving. Level of Evidence: Level 1 Economic Study.Plain Language Summary: Postoperative complications after fracture fixation adversely impact clinical outcomes and impose substantial economic burden. Conditionally essential amino acids (CEAA) have been shown to reduce postoperative complication rates, but the economic impact is unclear.In this study, we quantify the impact of CEAA on health care costs and quality of life related to postoperative complications.The model demonstrates significant cost savings ($4902 per year per patient with operative treatment for fracture fixation) from the use of CEAA supplementation. Improving health outcomes and reducing health care costs for patients undergoing operative treatment for fracture fixation will be increasingly important for health systems as US payers increasingly shift provider reimbursement towards value-based care.Keywords: postoperative complications, orthopedic surgery, fracture fixation, oral nutritional supplement, economic impact postoperative complications

Summary: Background: The protection of fourth dose mRNA vaccination against SARS-CoV-2 is relevant to current global policy decisions regarding ongoing booster roll-out. We aimed to estimate the effect of fourth dose vaccination, prior infection, and duration of PCR positivity in a highly-vaccinated and largely prior-COVID-19 infected cohort of UK healthcare workers. Methods: Participants underwent fortnightly PCR and regular antibody testing for SARS-CoV-2 and completed symptoms questionnaires. A multi-state model was used to estimate vaccine effectiveness (VE) against infection from a fourth dose compared to a waned third dose, with protection from prior infection and duration of PCR positivity jointly estimated. Findings: 1298 infections were detected among 9560 individuals under active follow-up between September 2022 and March 2023. Compared to a waned third dose, fourth dose VE was 13.1% (95% CI 0.9 to 23.8) overall; 24.0% (95% CI 8.5 to 36.8) in the first 2 months post-vaccination, reducing to 10.3% (95% CI −11.4 to 27.8) and 1.7% (95% CI −17.0 to 17.4) at 2–4 and 4–6 months, respectively. Relative to an infection >2 years ago and controlling for vaccination, 63.6% (95% CI 46.9 to 75.0) and 29.1% (95% CI 3.8 to 43.1) greater protection against infection was estimated for an infection within the past 0–6, and 6–12 months, respectively. A fourth dose was associated with greater protection against asymptomatic infection than symptomatic infection, whilst prior infection independently provided more protection against symptomatic infection, particularly if the infection had occurred within the previous 6 months. Duration of PCR positivity was significantly lower for asymptomatic compared to symptomatic infection. Interpretation: Despite rapid waning of protection, vaccine boosters remain an important tool in responding to the dynamic COVID-19 landscape; boosting population immunity in advance of periods of anticipated pressure, such as surging infection rates or emerging variants of concern. Funding: UK Health Security Agency, Medical Research Council, NIHR HPRU Oxford, Bristol, and others.

Observational assessments of parent-adolescent conflict can guide interventions to prevent and reduce conflict and mental health problems. The authors identified the Observing Mediational Interactions (OMI) as a particularly useful coding system for examining parent-adolescent conflict. The OMI is the observational measure used in the Mediational Intervention for Sensitizing Caregivers (MISC) and quantifies emotional (attachment-based) and cognitive (learning-based) behaviors during caregiver-child interactions.

Nathan Mitchell Kerr,1– 3 Sophia Moshegov,4 Samantha Lim,3 Maria Simos3 1Centre for Eye Research Australia, Melbourne, VIC, Australia; 2Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; 3Eye Surgery Associates, Melbourne, VIC, Australia; 4Department of Ophthalmology, The Royal Melbourne Hospital, Melbourne, VIC, AustraliaCorrespondence: Nathan Mitchell Kerr, Centre for Eye Research Australia, Level 7, 32 Gisborne St, East Melbourne, VIC, 3002, Australia, Tel +61 3 9929 8360, Email nathan.kerr@eyeandear.org.auPurpose: This study aimed to evaluate and compare visual outcomes, spectacle independence, and patient satisfaction on bilaterally implanted Vivity extended depth-of-focus (EDOF) or monofocal intraocular lenses (IOLs) after cataract surgery in patients with early glaucoma.Patients and Methods: In this retrospective, non-randomized, interventional cohort study, patients with early glaucoma undergoing cataract surgery received bilateral implantation of either EDOF (AcrySof IQ Vivity; Alcon) or monofocal (Clareon/SN6ATx/SN60WF; Alcon) IOLs. The primary outcome was monocular uncorrected intermediate visual acuity (UIVA). The secondary outcomes were monocular uncorrected distance (UDVA) and near (UNVA) visual acuity, spectacle independence, patient satisfaction, and photic phenomena. Fifty-eight eyes from 29 patients, including 32 eyes in the EDOF group and 26 eyes in the monofocal group, were included in the study.Results: UIVA (0.06 ± 0.16 versus 0.39 ± 0.10 LogMAR; P < 0.001) and UNVA outcomes (0.29 ± 0.10 versus 0.55 ± 0.18 LogMAR; P < 0.001) were significantly better in the EDOF group than in the monofocal group, respectively. There was no difference in UDVA and corrected distance visual acuity outcomes between the groups (P > 0.05), but both spectacle independence and patient satisfaction scores were significantly higher in the EDOF group (P < 0.001 and P < 0.05, respectively). There was no difference in self-reported photic phenomena.Conclusion: Bilaterally implanted EDOF IOLs provided excellent distance vision and better intermediate and near vision than monofocal IOLs in patients with early glaucoma. Spectacle independence and patient satisfaction were significantly higher in patients who received EDOF IOLs. Photic phenomena were rare and seldom bothersome.Keywords: cataract, intraocular lenses, glaucoma